Halton residents requiring liquid B12 prescriptions could soon get a bit of relief as a limited supply of the in-demand injectable vitamin will hit the shelves at some pharmacies later this month.
Liquid B12, which is typically sold in 60 ml bottles lasting about 10 months, has been in scare supply since the spring of 2012.
Injections act as an alternative to the pill form and are prescribed to those who are unable to naturally absorb the vitamin most commonly found in dairy and meat products.
David Jensen, spokesperson for the Ontario Ministry of Health, said that as the product becomes available there would be some supply irregularities after the initial backorder period.
“The ministry will work with manufacturers to monitor inventory closely and ensure an appropriate distribution of the stock across health centres in Ontario in order to minimize any further supply disruptions,” Jensen said.
The two biggest manufacturers of liquid B12 are Sandoz Canada and Cytex Pharmaceuticals Inc., both of which have experienced their own share of problems with getting the product back on shelves across Canada.
Cytex continues to have issues with the contracted manufacturing of their product, cyanocobalamin — a chemical compound found in B12.
“Increased production demands for the product have led to issues with one contract manufacturer,” said Jensen. “A second contract manufacturer, located in Europe, is reported to have had to re-tool part of their production line as a result of government inspection and validation studies.”
Information received by the ministry from Sandoz explains that the company “did not prioritize B12 injection over critical care products…since there was another supplier of Vitamin B12 in the market to respond to total customer care demand,” Jensen said.
Zak Patel, pharmacy manager at Zak’s Pharmacy in Milton, said he ordered 100 bottles of liquid B12 from Sandoz but only received three in late March.
“People have been waiting for it since December,” Patel said, acknowledging that customers have been “very frustrated or upset.”
A supply of B12 from Cytex is expected to become available to pharmacies the third week of April.
According to the Dieticians of Canada website, B12 is needed to form red blood cells but up to 30 per cent of older adults may have trouble absorbing the vitamin.
“A lot of the people that take it have anemia — they can’t absorb B12 through the gut — so that’s why they get it injected especially as they get older,” Patel said.
The same is true for people who have had their ileum removed — the part of the intestine where B12 is absorbed. It’s a procedure performed on those with Crohn’s disease.
Others still might require B12 supplements if they have trouble naturally secreting stomach acid to properly absorb the vitamin.
Dr. Stephanie Atkinson, associate chair in the Department of Pediatrics at McMaster University, said most people store B12 naturally in their body.
“If you had normal B12 status, you would have normal blood level and you would have some stored away in your liver and its replete would probably last you about six months,” she said.
Atkinson said she disputes a common misconception that B12 pills can’t be taken in place of injections.
“I think some people have had the misunderstanding that if you’re B12 deficient you have to have injections — that supplements won’t work,” she said.
B12 injections are appropriate for initial diagnoses of deficiencies but “once you’ve got that in you then you can survive on supplements,” she said.
Burlington pharmacist Rahim Mussani said the last stock of liquid B12 his pharmacy received “flew off the shelves.”
Since July of 2013 he’s only been able to order about a dozen 60 ml bottles from Sandoz for his patients.
“I’ve had our regular patients asking, but I’ve also had random people calling to ask if we have any,” he said, adding that for a while he was having a few inquiries each week from people looking to fill prescriptions.
Across Halton, there have been no reported shortages at long-term care facilities.
Halton Healthcare Services (HHS) spokesperson Trish Carlton said the hospitals experienced “significant supply problems” after the initial 2012 shortage but have since been able to meet patient demands.
“Measures were taken by HHS to mitigate the shortage, most notably increasing the use of oral tablets instead where feasible,” she said. “The HHS supply of injection was reserved for use in the small number of cases where oral doses were not appropriate.”

'If you had normal B12 status, you would have normal blood level and you would have some stored away in your liver and its replete would probably last you about six months.' - Dr. Stephanie Atkinson, McMaster University